Healthcare Provider Details

I. General information

NPI: 1497169361
Provider Name (Legal Business Name): JOHN BUMP D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

IV. Provider business mailing address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

V. Phone/Fax

Practice location:
  • Phone: 817-433-5000
  • Fax:
Mailing address:
  • Phone: 817-433-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS4736
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: